Distribution and antimicrobial resistance of pathogens causing bloodstream infection in a hospital in Sanya city / 中国感染控制杂志

Objective To understand the distribution and antimicrobial resistance of pathogens isolated from blood culture in a hospital in Sanya city.Methods Blood culture specimens and antimicrobial susceptibility testing results in this hospital from January 2013 to December 2015 were analyzed retrospectively.Results A total of 356 isolates of pathogenic bacteria were isolated from 3 195 blood culture specimens,the positive rate was 11.14％,including 215(60.39％)gram-negative bacterial strains,122(34.27％) gram positive bacterial strains,and 19(5.34％) fungi strains.The top 3 gram negative bacteria were Escherichia coli (n =90,25.28％),Klebsiella pneumoniae (n =60,16.85％),and Burkholderia pseudomallei (n =24,6.74％);the most common gram positive bacteria were Staphylococcus aureus (n =42,11.80 ％),coagulase-negative staphylococcus (n =38,10.67 ％),and Streptococcus spp.(n =33,9.27 ％).Resistance rates of Escherichia coli and Klebsiella pneumoniae to cefoperazone/sulbactam,amikacin,and carbapenems were all lower than 10.00％;resistance rates of Burkholderia pseudomallei to most antimicrobial agents were lower than 10.00％.There were no strains of main gram-positive bacteria that were found to be resistant to linezolid and vancomycin.Conclusion Gram-negative bacteria are the main pathogens causing bloodstream infection in this hospital in recent years,especially the isolation rate of Burkholderia pseudomallei is higher,which should arouse more attention in clinic.

Investigation of diagnostic method and treatment on acute appendicitis with acute intestinal obstruction as presenting manifestation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>Prevention of the misdiagnosis of acute appendicitis when it first manifested as acute intestinal obstruction, and to search proper way of diagnosis and treatment for such event to provide the reference.</p><p><b>METHODS</b>Clinical data of 33 acute appendicitis cases presented with acute intestinal obstruction in Beijing Tong Ren Hospital during January 2000 and December 2015 were analyzed retrospectively.</p><p><b>RESULTS</b>All 33 patients were admitted to the Emergency Department with symptoms of various degrees abdominal pain and abdominal distension. There was no passage of gas and feces. The mean time of onset was (62.2±25.0) hours. The imaging examination showedthat all patients had complete bowel obstruction. Twenty one patients(63.6%) had peritonitis, three of whom developed with septic shock. Abdominal CT was performed in 17 patients preoperatively, which showed retention of gas and fluid in the small intestine in all the patients and 13 were suggestive of acute appendicitis. All of these patients received surgical treatment, 12 patients underwent laparoscopic exploration, and the remaining 21 patients received exploratory laparotomy during which acute appendicitis was confirmed to be the cause of intestinal obstruction, of whom 14(42.4%) was identified as mechanical intestinal obstruction. Nine patients underwent appendectomy and lysis of adhesion, five appendectomy and partial excision of the greateromentum. Nineteenpatients(57.6%) were identified as paralytic ileus and underwent appendectomy only. Twelve patients required respiratory and circulatory support and were admitted to ICU postoperatively. The mean duration time in ICU was(8.8±5.2) days. Postoperative pathology showedgangrene accompanied with perforation in the appendix. All patients were discharged without any complication. The length of hospital stay was (15.4±4.6) days. All patients were followed up for 3 ~ 12 months. One patient with chronic obstructive pulmonary disease developed repeated pulmonary infection and died of respiratory failure at 185 days postoperatively. The remaining patients were followed up and there were no patients developed intra-abdominalsepsis, intestinal obstruction, surgery-related complications, or death.</p><p><b>CONCLUSION</b>Patients with acute appendicitis presenting with acute intestinal obstruction are mostly in severe condition. Clinical diagnosis for this patients is difficult and surgery should be performed as soon as possible.</p>

Impact of glucagon-like peptide-1 receptor agonists on nasopharyngitis and upper re-spiratory tract infection among patients with type 2 diabetes:a network meta-analy-sis / 北京大学学报(医学版)

Objective:To systematically review the effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs)on two common respiratory system adverse events (RSAE:nasopharyngitis and upper re-spiratory tract infection)among type 2 diabetes (T2DM).Methods:Medline,Embase,Clinical trials and Cochrane library were searched from inception through May 201 5 to identify randomized clinical trials (RCTs)assessed safety of GLP-1 RAs versus placebo or other anti-diabetic drugs in T2DM.Network meta-analysis within a Bayesian framework was performed to calculate odds ratios for the incidence of RSAE.Results:In the study,50 RCTs were included,including 1 3 treatments:7 GLP-1 RAs (exenati-de,exenatide-long-release-agent,liraglutide,lixisenatide,taspoglutide,albiglutide and dulaglutide), placebo and 5 traditional anti-diabetic drugs(insulin,metformin,sulfonylureas,sitagliptin and thiazo-lidinediones ketones).Compared with insulin,taspoglutide significantly decreased the incidence of naso-pharyngitis (OR =0.67,95%CI:0.46 -0.96).Significant lowering effects on upper respiratory tract infection were found when taspoglutide versus placebo (OR =0.57,95%CI:0.34 -0.99)and insulin (OR =0.39,95%CI:0.23 -0.73).The result from the network meta-analysis based on Bayesian theo-ry could be used to rank all the treatments included,which showed that taspoglutide ranked last with mi-nimum risk on nasopharyngitis and upper respiratory tract infection.Conclusion:Taspoglutide was associ-ated with significantly lowering effect on RSAE.

Epidemiological survey on related risk factors of newborn infant with Down′s syndrome in Sanya city / 重庆医学

Objective To investigate the incidence of live births with Down syndrome(DS) in Sanya city as well as to discuss the related risk factors .Methods The object of investigation was the 25 032 infants who were born in Sanya city ,then the children with clinical suspected of DS were confirmed by peripheral blood chromosome analysis .Meanwhile ,the clinical data of children and their parents were collected ,calculating the incidence of DS in this region and analyzing the related risk factors .Results In this region , the total incidence of DS was 0 .959‰ ,the incidences in the Han nationality and Li nationality were 0 .834‰ ,1 .442‰ respectively . The mean age of DS children′s mother was 29 .8 years old ,and the incidence of DS increased as their mother grew older .Before pregnancy ,DS children′s mother who had an exposure history of toxicant and drugs accounted for 45 .8% .Conclusion The inci‐dence of DS in Sanya is quite high ,so it is extremely essential to strengthen the women′s pregnancy Down syndrome screening and improve the prenatal diagnosis in this region .

The incidence of the main adverse events of thoracic/abdominal aortic coated graft: a systematic review and meta-analysis / 中华胸心血管外科杂志

Objective The purpose of this study was to review all published reports on thoracic/ abdominal stent graft and investigate the incidence rates of six main adverse events(MAEs):myocardial infarction,paraplegia,renal failure,respiratory failure,stroke and all-cause mortality.Methods Electronic databases(PubMed、Embase、OVID、ProQuest、Elsevier and The Cochrane Library) were searched from inception through May 2014 to identify studies that assessed the safety of thoracic/abdominal aortic coated stents on MAEs.The incidence rates with 95％ confidence intervals(95％ CIs) were derived using a random effects model,considering the heterogeneity between the included studies.Subgroup and sensitivity analyses were applied to explore heterogeneity.Results A total of 152 studies were included in the analysis with 264 arms.For thoracic stent graft,meta-analysis yielded a combined estimated incidence rates of 12.2％,and the most common MAEs was all-cause mortality (8.1％),followed by respiratory failure (6.5 ％).For abdominal stent graft,meta-analysis yielded a combined estimated incidence rates of 4.6％,and the most common MAEs was all-cause mortality(4.0％),followed by myocardial infarction(2.1％).For thoracic and abdominal stent graft,subgroup analysis stratified by age and proportion of males indicated that middle-aged and females have a higher incidence rates of all-cause mortality.Besides,subgroup analysis stratified by follow-up time indicated that the longer follow-up time,the higher incidence rate of all-cause mortality.Conclusion The current evidence indicates that the incidence of MAEs of thoracic and abdominal stent graft is high,and we should pay more attention to the patients and follow up them as long as possible.

Role of the small intestinal decompression tube and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the role of the small intestinal decompression tube (SIDT) and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction (EPISBO).</p><p><b>METHODS</b>Twelve patients presented EPISBO after abdominal surgery in our department from April 2011 to July 2012. Initially, nasogastric tube decompression and other conventional conservative treatment were administrated. After 14 days, obstruction symptom improvement was not obvious, then the SIDT was used. At the same time, Gastrografin was injected into the small bowel through the SIDT in order to demonstrate the site of obstruction of small bowel and its efficacy.</p><p><b>RESULTS</b>In 11 patients after this management, obstruction symptoms disappeared, bowel function recovered within 3 weeks, and oral feeding occurred gradually. Another patient did not pass flatus after 4 weeks and was reoperated. After postoperative follow-up of 6 months, no case relapsed with intestinal obstruction.</p><p><b>CONCLUSION</b>For severe and long course of early postoperative inflammatory intestinal obstruction, intestinal decompression tube plus Gastrografin is safe and effective, and can avoid unnecessary reoperation.</p>

MTA1 in tumor progression and metastasis / 国际外科学杂志

MTA1 is a composition of Nurd,which may deacetylate histone and non-histone to affect gene transcription and protein expression. Since it is often overexpressed in many tumors and closely related to invasion,metastasis and prognosis of the malignancy, MTA1 might be exploited as a tumor marker for clinical application. This article reviews the structure and function of MTA1 and some new research progress on the tumor metastasis related to MTA1.

Perioperative treatment effects of colorectal cancer in elderly patients / 中华老年医学杂志

Objective To explore the clinical features and perioperative treatment effects of colorectal cancer in elderly patients.Methods Retrospective analysis of clinical data especially focusing on perioperative treatment from 104 elderly patients with coloreetal cancer were performed.Results A total of 99 patients (95.2%) were cured or improved at discharge.Perioperative pulmonary infection occurred in 13 cases (12.5%), of whom 6 cases (5.8%) suffered from respiratory failure.Lower extremity deep venous thrombosis occurred in 3 cases (2.9%), incision infection in 6 cases (5.8%), wound dehiscence in 2 cases (1.9%), intestinal fistula in 1 case (1.0%) and gastroparesis in 1 case (1.0%).About 5 cases (4.8%) died from multiple organ failure.Conclusions Old age is not a contraindication in surgical treatment for colorectal cancer.Paying attention to accurate and timely treatment in perioperative peroid can reduce postoperative complications and improve patients' quality of life.

Value of magnetic resonance imaging for breast - conserving surgery / 中华普通外科杂志

Objective To evaluate magnetic resonance imaging (MRI) for breast-conserving surgery. Methods In this study, 52 cases of breast cancer eligible for breast-conserving surgery judged by traditional screening methods from May 2004 to December 2007 were inspected preoperatively with MRI in order to detect the cases of muhicentric breast cancer. At the same time, tumor size and invasive extent was measured accurately with enhanced magnetic resonance sequence combined with fat-suppression to determine the minimally extent of the surgical excision required. Results In the 52 cases of breast cancer patients, 3 cases of multicentric breast cancer and 49 cases of single breast cancer were diagnosed by MRI ,there were 3 cases with extensive intraductal carcinoma in the cases of single breast cancer. The primary negative margin rate was 93.6% (44/47) in the 47 cases with breast-conserving surgery. Conclusions MRI has thesuperiority to detect the muhicentric disease and the extensive intraductal carcinoma of breast cancer.Therefore MRI is useful in determining the indication and the extent of surgical excision of breast-conservingsurgery.

Serological epidemiology study of HPV-6,11,16,18 in Shanxi rural women / 中华微生物学和免疫学杂志

status.Conclusion HPV6 and HPV-16 were the most two popular HPV types in the whole population,while HPV-16 was the most common type in CIN2+ population.HPV-16 seroprevalence increased with severity of cervical intraepithelial neoplasia.

Neoadjuvant chemotherapy for advanced gastric cancer / 国际外科学杂志

At present, most of patients diagnosed as gastric cancer with clinical therapy belong to ad- vanced stage in China; The patients in early stage are relatively few. While patients in advanced stage have poor prognosis in general and low rate of curative resection. Neoadjuvant chemotherapy for advanced gastric cancer can obtain downstaging, increase rate of curative resections, and has the possibility of improving sur- vival. Neoadjuvant chemotherapy might be an effective and feasible therapeutic method for advanced gastric cancer.

The diagnosis and surgical treatment of primary gastric lymphoma / 中华普通外科杂志

Objeetive To probe the clinical diagnosis and surgical treatment of primary gastric lymphoma (PGL). Methods Clinical data of 23 PGL patients identified by postoperative pathology were analyzed retrospectively. Sixteen patients underwent subtotal gastrectomy,3 patients underwent total gastrectomy,2 patients underwent palliative resection and 2 patients underwent exploratory laparotomy only. Postoperatively 21 patients received adjuvant treatment(chemotherapy and/or radiotherapy).The variables analyzed were type of surgery, histological type in accordance with Kiel's classification, Involvement of lymph nodes. Ann Arbor stage classification. Results The overall 5-year survival rate of these patients Was 80%,that of low grade malignancy patients was 90%,and of high grade malignancy was 40%.Thirteen patients were classified as stage Ⅰ E and seven as stageⅡE and three as stageⅢor Ⅳ,the 5-year survival rate was 90%,67%and 0,respectively.Nineteen patients underwent radical resection with 5-year survival rate of 92.3%.No patients undergoing palliative resection have survived more than 5 years. The prognosis of PGL with low grade malignancy and that of early stages(IE and Ⅱ E)and those undergoing radical excision was better than those with high grade malignancy, that of advanced stage(Ⅲand Ⅳ),and that undergoing palliative resection. Conclusions Preoperative diagnosis relies mainly on gastroscopy with biopsy and CT scan. For patients with early stage disease,radical resection combined with adjuvant therapy is the key factor in improving the prognosis. Chemotherapy or/and radiotherapy is useful management for patients with advanced stage disease.

Application of SELDI-TOF-MS in searching for biomarkers for colorectal cancer / 国际外科学杂志

SELDI-TOF-MS is a novel proteomic technique.It reveals some new biomarkers which could be used for early diagnosis,preoperative staging and predicting response to radiochemotherapy of colorectal cancer.These new biomarkers were validated to be more sensitive and specific than traditional hiomarkers.SELDI-TOF-MS will be a useful tool for early diagnosis and tailor-made therapy of eolorectal cancer.

Application of magnifying colonoscopy in diagnosis and treatment of colorectal neoplastic lesions / 中国康复理论与实践

@#ObjectiveTo evaluate the clinical value of magnifying endoscopy in diagnosis and treatment of colorectal benign neoplastic lesions.Methods78 colorectal lesions in 61 patients were examined with magnifying colonoscopy after indigo carmine dye, and a pit pattern diagnosis was made for every lesion according to Kudo's classification.All the lesions were totally resected, and the specimen were sent for pathologic examinations.ResultsThe diagnostic sensitivity of neoplastic lesions was 98.4% and specificity was 85.7% when types Ⅰ and Ⅱ represented the pit pattern of nonneoplastic lesions, whereas types Ⅲ, Ⅳ, and Ⅴ represented adenoma and early colorectal cancer. The overall accuracy in differentiating adenoma and early colorectal cancer from nonneoplastic lesions was 96.2%.94.5% of adenomarous lesions were treated by colonoscopy.ConclusionThe magnifying colonoscopy can provide an instantenous accurate diagnosis of tumorous lesions in colon and rectum. Synchronize, minimally invasive and curative treatment is possible to be completed by using it for a large number of lesions.

Effects on micro-vessel density after pre-operative intra-arterial infusion chemotherapy in colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the effects of pre-operative intra-arterial infusion chemotherapy on colorectal cancer.</p><p><b>METHODS</b>Twenty-eight patients with colorectal cancer, treated by surgery from February to October 2000, were divided into two groups randomly. There were 12 patients in group A (pre-operative intra-arterial infusion chemotherapy) and 16 in group B (control). Arterial contrast technique was used in group A, then mitromycin 10 mg, 5-Fu 1,000 mg, epirubicin 60 mg were given through Weidner's way.</p><p><b>RESULTS</b>Micro-vessel density in the center, surface of the tumor and adjacent tissue around the tumor were 40.46 +/- 7.06, 52.27 +/- 18.40, 49.92 +/- 8.15 in group A, and 46.09 +/- 12.21, 73.44 +/- 22.06, 51.94 +/- 12.64 in group B. Micro-vessel density on the surface in group A was significantly lower than that of group B (P < 0.05), with no significance between the center and the adjacent tissue.</p><p><b>CONCLUSION</b>Pre-operative intra-arterial infusion chemotherapy is able to reduce micro-vessel density on the surface of colorectal tumor.</p>

Colonoscopy in preoperative staging and treatment of colorectal cancer / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the value of colonoscopy for the diagnosis and preoperative staging of colorectal cancer, and evaluate the significance of correct preoperative staging in guiding treatment.</p><p><b>METHODS</b>28 patients with colorectal cancer were examined by general colonoscopy, magnifying endoscopy and endoscopic ultrasonography before operation. Preoperative staging, and proper treatment protocols were made.</p><p><b>RESULTS</b>Endoscopy revealed that 15 of the 28 patients had early colorectal cancer and 13 advanced colorectal cancer. The correct diagnosis rate for preoperative staging was 100%; the accuracy of penetrating depth was 89% (25/28). In the early cases, tumour invasion was confined to mucosal layer in 11 patients and submucosal layer in 4. Six patients with early cancers 6 cm from the anus were treated by endoscopic mucosa resection (EMR) or EMR combined with open surgery. No postoperative recurrence was found by endoscopy during the period of follow-up for 12 - 40 months.</p><p><b>CONCLUSION</b>Correct preoperative staging for colorectal cancer is of important significance in guiding treatment, especially in early staging cases. In order to improve the quality of life for colorectal cancer patients, we should treat them with individualized operation based on curative resection.</p>

Risk factors relevant to postoperative recurrence in patients of nodular goiter / 中国普通外科杂志

ObjectiveTo study relevant factors for the postoperative recurrence in patients of nodular goiter. Method Nine clinical factors were recruited for the study in relation to postoperative recurrence of 230 patients with nodular goiter.Data were analyzed by ? 2 test and Logistic regression.Result Two independent factors were found significantly in relation to recurrence(B=-1 652?6,B=1 070?7, P

The use of drainage after radical resection for rectal carcinoma / 临床外科杂志

Objective To summarize the experience of the use of drainage after radical resection for rectal carcinoma.Methods 87 cases of patients who underwent radical resection for rectal carcinoma from May 1996 to May 2000 were reviwed retrospectively.Results Among 40 cases who underwent abdominoperineal resection(APR),perineal wounds were healed at one stage in 37 case,perineal wound infections occurred in 3 case,bleeding in one case and bowel obstruction in one case.among the other 47 cases who underwent low anterior resection(LAR),intrapelvic infection occurred in one case,anastomosis leakage occurred in one case.Conclusions The use of drainage after radical resection for rectal carcinoma is a very important method to reduce the occurrence of local complications.

Modern surgical treatments for congenital choledochal cysts complicated with anomalous junction of pancreaticobiliary ductal system: an analysis of 30 cases / 中华肝胆外科杂志

Objective To discuss the modern surgical treatments for congenital choledochal cysts complicated with anomalous junction of pancreaticobiliary ductal system through analyzing data in 30 cases. Methods The 30 cases were diagnosed with ERCP, MRCP, cholangiography or dissection, respectively. Then 28 of them were treated with external drainage (n=2), internal drainage (n=9) and Roux-en-Y hepaticojejunostomy (n=22), respectively. Of the 28, 5 received operations twice. Results External drainage was helpful in emergency cases while internal drainage frequently resulted in recurrent cholangitis, choledocholith, anastomotic stenosis or cyst malignancy that needed to be operated on again. Choledochocyst resection and pancreaticobiliary shunt achieved satisfactory results. Conclusions Congenital choledochal cyst is usually complicated with anomalous junction of pancreaticobiliary ductal system (88.2%). As for its treatment, choledochocyst resection, pancreaticobiliary shunt and hepaticojejunostomy should be of the first choice.

Effect of preoperative regional intra-arterial chemotherapy on serum vascular endothelial growth factor and endotatin levels in patients with colorectal carcinoma / 中国普通外科杂志

Objective To determine serum vascular endothelial growth factor (s-VEGF) and serum endostatin (s-endostatin) levels in patients with colorectal cancer after preoperative regional intraarterial chemotherapy (PRAC). Methods Peripheral venous blood was sampled preoperatively and postoperatively, and was assayed for VEGF and endostatin by ELISA. Results Patients' preoperative level of s-VEGF and s-endostatin elevated significantly, which was in close correlation with Dukes' stage. The level of s-VEGF and s-endostatin before chemotherapy elevated significantly compared with that on day 7 after chemotherapy and on postoperational day 1 and 14 after operation. In patients undergoing palliative resection, only the level of s-endostatin before chemotherapy was significantly higher than that on day 1 after operation. Conclusions PRAC, inhibiting angiogenesis, is of antitumor effect, the decrease of s-endostatin after chemotherapy may suggest the combination of chemotherapy and antiangiogenesis for a better antitumor effect.